Target organ damage and incident type 2 diabetes mellitus: the Strong Heart Study

Giovanni de Simone, Wenyu Wang, Lyle G Best, Fawn Yeh, Raffaele Izzo, Costantino Mancusi, Mary J Roman, Elisa T Lee, Barbara V Howard, Richard B Devereux, Giovanni de Simone, Wenyu Wang, Lyle G Best, Fawn Yeh, Raffaele Izzo, Costantino Mancusi, Mary J Roman, Elisa T Lee, Barbara V Howard, Richard B Devereux

Abstract

Background: Recent analyses in a registry of hypertensive patients suggested that preceding left ventricular (LV) hypertrophy (LVH) and/or carotid atherosclerosis are associated with incident type 2 diabetes, independent of confounders. We assess the relation between prevalent cardio-renal target organ damage (TOD) and subsequent incident type 2 diabetes in a population-based study with high prevalence of obesity.

Methods: We selected 2887 non-diabetic participants from two cohorts of the Strong Heart Study (SHS). Clinical exam, laboratory tests and echocardiograms were performed. Adjudicated TODs were LVH, left atrium (LA) dilatation, and high urine albumin/creatinine ratio (UACR). Multivariable logistic regression models were used to identify variables responsible for the association between initial TODs and incident diabetes at 4-year follow-up (FU).

Results: After 4 years, 297 new cases of diabetes (10%) were identified, 216 of whom exhibited baseline impaired fasting glucose (IFG, 73%, p < 0.0001). Participants developing type 2 diabetes exhibited higher inflammatory markers, fat-free mass and adipose mass and higher prevalence of initial LVH and LA dilatation than those without (both p < 0.04). In multivariable logistic regression, controlling for age, sex, family relatedness, presence of arterial hypertension and IFG, all three indicators of TOD predicted incident diabetes (all p < 0.01). However, the effects of TOD was offset when body fat and inflammatory markers were introduced into the model.

Conclusions: In this population-based study with high prevalence of obesity, TOD precedes clinical appearance of type 2 diabetes and is related to the preceding metabolic status, body composition and inflammatory status. Trial registration Trial registration number: NCT00005134, Name of registry: Strong Heart Study, URL of registry: https://ichgcp.net/clinical-trials-registry/NCT00005134, Date of registration: May 25, 2000, Date of enrolment of the first participant to the trial: September 1988.

Keywords: Arterial hypertension; Body composition; Inflammation; Left atrial dilatation; Left ventricular hypertrophy; Target organ damage.

Figures

Fig. 1
Fig. 1
Selection of the study population from the original cohort of non-diabetic participants to the Strong Heart Study and the Strong Heart Family Study
Fig. 2
Fig. 2
Risk of development of diabetes (expressed as OR and 95% of confidence interval) based on three indicator of target organ damage: LV hypertrophy (white circles), LA dilatation (grey circles) and high urinary albumin/creatinine excretion (black circle). All p value <0.05 except in Model 4

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